CRITICAL APPRAISAL

Title

Systematic review of decreased

intracranial pressure with optimal
head elevation in postcraniotomy
patients: a meta-analysis
 Researchers

JIANG Y. , YE Z.P . - P . , YOU C. , HU X . , LIU Y . ,

LI H. , LIN S . & L I J . - P
Published

March, 27 2015
Background

Intracranial pressure (ICP) is pressure inside

the skull and ICP in brain tissue or cerebrospinal
fluid is normally 7-15 mmHg in a supine adult.
Craniotomies are surgical operations, which
involveremoving a bone flap from the skull and
are performed on patients suffering from
traumatic brain injury (TBI), Parkinson’s disease,
epilepsy and cerebellar tremor.
 Tankisi and Cold (2007) determined that the
optimal degree of elevation in most patients is 15
degrees when in the reverse Trendelenburg
position; however, Winkelman (2000) found that
ICP can be improved significantly and clinically
when patients with increased ICP are elevated to
30 degrees. There is no metaanalysis published
concerning the optimal degree that decreases ICP
in postcraniotomy patients.
 Many former articles suggested a change in
head positioncan lead to a change in
intracranial pressure; however, there are
conflicting data regarding the optimal degree
that decreases intracranial pressure in
postcraniotomy patients.
The Aim

To determine an optimal head elevation

degree to decrease intracranial pressure in
postcraniotomy patients by meta-analysis
Place and time of research
China, Dating from 1960 until January 2014
Sampling

The total number of cases included in this study

was 237
Instrument

Systematic review
Intervention

Head elevation of 10, 15, 30 and 45 degrees

Data Analyzed

Data were analysed with Review Manage

Version 5.0.24 (RevMan 5.0.24) software,
which was downloaded from the Cochrane
Library. We regarded P < 005 as statistically
significant.
 Result
These included a total of 237 participants who
were included in the meta-analysis.
1. Compared with 0 degree: 10, 15, 30 and 45
degrees of head elevation resulted in lower
intracranial pressure.
2. Intracranial pressure at 30 degrees was not
significantly different in comparison to 45
degrees and was lower than that at 10 and
15 degrees.
Conclusion

 Patients with increased intracranial pressure

significantly benefitted from a head elevation
of 10, 15, 30 and 45 degrees compared with 0
degrees.
 A head elevation of 30 or 45 degrees is
optimal for decreasing intracranial pressure.